Priya had to quit her well-established corporate job when she “finally” got pregnant at 29. She was living with her husband, Rohit, in Delhi at that time. Since Rohit was busy with his work back then that involved frequent trips to the US, she expressed the desire of giving birth in her home town Pune with her mom around, who could help her through the pregnancy.

When her husband suggested that she could do the same in his hometown Jaipur at their “real” home and mother-in-law to take care of her, she explained to him that since her mother-in-law herself was mostly dependent on her servants, it would be more convenient for her to do it with her mom around. While her husband agreed, it was an impossible task to reason with her mom-in-law.

The mother-in-law denied her pleas and found a doctor for her in Jaipur. Priya thus spent most of her pregnancy in Jaipur with her mom-in-law constantly reminding her every day that she had to give birth to a baby boy. Rohit, for the majority of the pregnancy, was abroad and she had to drag herself to do the kind of things that she could have easily asked her mom to do, had she been at her home.

At the time of labour due to some unforeseen complications she had to undergo a C-section instead of a normal delivery as the doctors had predicted. Already tired and jaded after the operation, soon after getting back to her senses she witnessed a random albeit regular fit by her mother-in-law who was lamenting the fact that her daughter-in-law had not taken proper care of the baby during pregnancy and almost put the “baby boy’s” life in danger.

She was lucky to spend the first one month of her postpartum period at her mom’s house in Pune but only because the customs stated so. As soon as she was back she was told by in-laws that the baby looked really weak and she should have taken care of him. Her mother-in-law who happened to be my aunt, hushed in my ear…Priya forgets everything as soon as she is at her mummy’s house. She forgot “our” poor baby too.

Babies don’t exactly follow our sleeping cycles and neither did Priya’s baby, she’d often stay up entire nights taking caring of his needs and thus got late waking up. I remember how the tension would be so palpable that you could cut it with a knife when she came out of her room after an all-nighter. My aunt would give her angry stares for getting up so late despite being the bahu of the house and setting a bad example.

When Priya’s husband finally got back to India permanently he observed some drastic changes in her behaviour. While he dismissed it for a while thinking that it’s because of the newly assumed motherhood, he after a month or so started feeling uneasy. He tried talking to her about the same but she was uninterested just like she was in everything else. This is when he talked to a number of friends who had become parents recently and two of them suggested him to seek expert help. This should not come as a surprise that Priya was diagnosed with acute depression and is still undergoing treatment for the same.

Infuriated as you might feel having read the story, the purpose here is not to elicit your anger but to make you aware of the importance that should be paid to maternal mental health.

IWB decided to seek expert opinion to help you understand the importance of it. We thus got in touch with Dr Deepak Goel, a psychiatrist, and DR Prabha S Chandra who is currently a  professor in the Department of Psychiatry, NIMHANS. We had a detailed chat with them on the topic of maternal mental health.

Maternal Mental Health

As per a study by Dr Goel, 30-75% women in the country suffer from postpartum blues and 10-15% of them are diagnosed with depression but hold on, they are just the reported cases. Despite the toll that pregnancy and childcare take on a new mother, not enough attention is paid to maternal mental health in our country.

Dr Chandra shared with us the right way of establishing the importance of maternal mental health and how it is integral to monitor a mother’s mental state for “1000 days of child’s life.” The initial 365 days out of 1000 are referred to as “fetal programming” and mostly encompass the phase when the baby is in the womb. The remaining 365*2 days are referred to as “maternal programming” and refer to the 2 years following the birth of the baby.

During the “1000 days of a child’s life,” the mother’s mental health and well being have a direct impact on the development of the child, both cognitive and physical. That is why paying adequate attention to the mother’s mental health in this phase is integral.

Dr Chandra said, “Antenatal screening for depression and anxiety is as important as that of diseases like diabetes, thyroid etc. as all of them directly impact the baby.”

Triggers of antenatal anxiety and depression

Dr Goel shared with us some of the triggers for antenatal anxiety and depression in mothers. He said, “It can be a variety of reasons including past history of psychiatric disorders, marital discord, some adverse life event, unwanted pregnancy, history of alcohol consumption or smoking and genetic.”

Symptoms of antenatal anxiety and depression

Sharing the symptoms of antenatal anxiety and depression in mothers, Dr Goel shared that “the symptoms might range from a loss of appetite, low mood, loss of weight, sleeplessness to even suicidal thoughts.” Imagine taking care of your child in this state of mind!

The stigma around depression

I ensured to ask both the doctors the reasons behind the deep and dark stigma that we associate with depression and how can we get rid of it.

Dr Chandra explained: “Firstly in India, we don’t understand the need of getting it diagnosed or treated. Lack of awareness on all sides including the health professionals, the mother, and the family actually plays a major role.” She added, “To top it, we create this myth around an expecting mother that she should be blooming, happy and glowing that stops her from coming out with her mental dilemma. In fact, a lot of times the obstetricians are aware that it is happening but they don’t want to open the Pandora’s box by pointing it out as they themselves are not sure if they are qualified enough to handle it.”

Fighting the stigma

Dr Goel remarked: “Awareness is a key factor here. We as a society need to do away with the labelling and get aware of the fact that depression is a biological thing and is treatable.”

We also assimilated points on doing away with the stigma from Dr Chandra. Here is how we can attempt at removing the stigma pertaining to antenatal depression and anxiety:

1. Impact on the baby

Once we understand and make others understand that a mother’s mental health directly impacts the child it would help a lot in removing the stigma as more people would pay attention to it.

2. Educating Obstetricians

There is a need to spread awareness among the obstetricians as well. Just like there are big boards in clinics screaming “Anemia can cause problems”, there also should be big boards stating “Depression can cause problems.”

3. Reassuring mothers or expecting mothers

We have observed that many times women avoid raising issues pertaining to their mental health even when they are aware of them because they are scared that they would be prescribed medications and they avoid such medications during pregnancy. There is a need to reassure them that are other ways that we can work out the treatment and also that these medicines will only help them.

Shared parenting

The onus of the childcare majorly lies on the shoulders of the mother and Dr Chandra shared that this is the condition in the developed countries as well and not just India. We took the opportunity to raise a question: “Can shared parenting help in this situation?”

Dr Goel answered, “Definitely! In a patriarchal society like India, the entire stress of childcare falls on the mother. Shared parenting can work wonders in relieving this stress.”

Dr Chandra gave us the specifics on how it can be done: “While there are a lot of things that fall entirely on the shoulders of the mother for the first 6 months of childcare there are many ways in which the spouse can help. For instance, sleep is a big problem with new moms and they find themselves sleep deprived most of the times. The spouses can help out in this situation by sharing the responsibilities and taking care of the baby whenever required so that the mother can get a good sleep every now and then.”

Dr Chandra, “The spouses can find out places where they can be helpful. For instance, they can take care of the elder child or do the cooking while the mother is handling the newborn.”

The Role of other family members

But like the case of Priya, there also is a requirement for certain set of behavioural guidelines for other family members in our country. We turned to the doctors to seek these guidelines. Dr Goel suggested that it is of utmost importance for the family to provide “good psychological support to the mother. The family should provide the mother with both nutritional and emotional support.”

Dr Chandra was kind enough to provide us with a set of guidelines that the families can follow:

1. Go easy with the rituals and guidelines

A new mom is thronged with never-ending rituals and guidelines like she can’t go out of the house for a certain period etc. All this results in a lot of stress for the mother. The families need to take into consideration the comfort of the new mom and go easy with the rituals.

2. Comments on the health of the baby and unnecessary comparisons

Irresponsible comments on the health of the baby can make the mother feel that she is doing something wrong and thus they should be avoided. Comparisons of this baby with another is also a futile exercise and should be avoided.

3. Reassuring the mother

Reassuring a woman that she is doing great with the baby can do wonders for her mental health.

4. Help her out with the baby

Help out the mother in soothing the baby or bathing him instead of wearing her down with baseless complaining.

The anxiety of giving birth

A lot of expecting mothers suffer from the anxiety of giving birth. Dr Chandra told us that, “while anxiety is not the same thing as depression, it can be as crippling as depression.” Talking about the anxiety of giving birth Dr Chandrsa said, “it has a name, it’s called Tocophobia and it is more common than you think.”

Dr Goel and Dr Chandra also gave us pointers to combat Tocophobia:

1. Knowledge and awareness

These days expecting mothers go to the internet and watch all the wrong kind of videos that aggravate them but if the moms-to-be access the right kind of literature then the knowledge can ease out the fear in them.

2. Time to approach your mothers and grandmothers

These women who have given birth in the traditional ways will reassure you that there is nothing that can possibly go wrong with all the expert attention that you are receiving.